Myomectomy

Myomectomy

A myomectomy is an operation performed to remove benign tumours called fibroids from the muscular wall of the uterus. Fibroids often cause pain and excessive menstrual bleeding. They can also interfere with your ability to become pregnant. They may degenerate or become infected, and therefore your doctor may feel they should be surgically removed. A hysterectomy may be suggested if you are over childbearing age.

Uterine fibroids

Fibroids are categorised by their locations, which include:•Intramural - in the uterine wall. Intramural fibroids are the most common variety.•Submucosal - in the uterine lining (endometrium). This type tends to cause excessive menstrual bleeding and period pain.•Subserosal - on the exterior wall of the uterus. They sometimes appear like long stalks.

Operation procedure

In most cases, the surgeon performs a dilatation and curettage (D&C) to check for irregularities in the inner surface of the uterus. The kind of myomectomy performed depends on the type, size, number and location of the fibroids, but can include:

•Abdominal myomectomy - the uterus is accessed via one large incision through the abdomen. Usually, a horizontal cut just on the bikini line is performed; in some cases, the incision may need to be made vertically in the midline of your abdomen. The uterus is cut, sometimes with a laser (which closes off blood vessels and reduces bleeding). The fibroids are then removed and the uterus, abdominal wall and skin are closed with sutures. This type of myomectomy is preferred for multiple or deeply rooted fibroids. The drawback of abdominal myomectomy is that it takes longer to recover.

•Laparoscopic myomectomy - subserosal fibroids can often be removed via laparoscopic (‘keyhole’) myomectomy. The surgeon makes a number of small incisions, which allow different instruments access to the uterus. Among these instruments is the laparoscope, which contains fibre-optic camera heads or surgical heads (or both). The fibroids are removed, and the small wounds sutured (sewn) closed. Recovery time for the patient is comparatively fast.

•Hysteroscopic myomectomy - the fibroids are removed via the dilated cervix, so no abdominal incisions are needed. The instrument is called a resectoscope, which is a hysteroscope fitted with a wire loop. The instrument is inserted through the cervix, and the wire loop slung over the fibroid. Electrical energy passes through the loop, which cuts the fibroid loose. The fibroid can then be removed through the vagina.

Taking care of yourself at home

Be guided by your doctor, but general suggestions include:• Try to rest as much as possible for two weeks.• Avoid standing for more than a few minutes at a time.• Continue to take your medications, and follow strictly the instructions on taking your antibiotics.• After two weeks, aim to walk for about 10 minutes every day, unless advised otherwise by your doctor.• Depending on the type of surgery, you can return to work within two to six weeks (abdominal myomectomy takes the longest recovery time).• If you have any excessive vaginal bleeding, or signs of infection at your wound site (such as redness, increasing pain, swelling, or an increased or offensive discharge from your wound), see your doctor immediately.